The Effect of Intravascular Imaging-Guided Percutaneous Coronary Intervention on Coronary Artery Perforation.

BACKGROUND

Intravascular imaging (IVI) complements coronary angiography and may help prevent coronary artery perforation (CAP) during percutaneous coronary intervention (PCI).

OBJECTIVES

The authors evaluated whether IVI-guided PCI is associated with a lower risk of PCI-related CAP in a real-world cohort.

METHODS

This observational study analyzed consecutive PCI procedures from January 2006 to October 2023. The procedures were divided into 4 groups according to the year performed: 2006 to 2010 (P1), 2011 to 2015 (P2), 2016 to 2020 (P3), and 2021 to 2023 (P4). We evaluated the trend of IVI-guided PCI and the incidence of CAP. A mixed effects logistic model was employed to assess their relationship.

RESULTS

CAP occurred in 368 (1.6%) of 22,368 PCIs. IVI-guided PCI accounted for 63% of all cases, of which 95% were intravascular ultrasound procedures. From P1 to P3, the ratio of IVI-guided PCI increased linearly (P1: 30%, P2: 61%, P3: 93%, P4: 97%), while the incidence of CAP decreased (P1: 2.10%, P2: 1.74%, P3: 1.13%, P4: 1.18%). IVI-guided PCI showed a significant association with a lower risk of the overall incidence of CAP (adjusted OR: 0.78; 95% CI: 0.61-0.99; 0.047). This relationship was particularly significant for chronic total occlusion PCI (adjusted OR: 0.59; 95% CI: 0.43-0.80; 0.001) and PCI for moderate or severe calcification (adjusted OR: 0.50; 95% CI: 0.33-0.74; 0.001).

CONCLUSIONS

IVI-guided PCI may help prevent PCI-related CAP, especially in the setting of chronic total occlusion PCI and PCI for moderate or severe calcification.